Organization · NPI-2

Aaa Waterford Medical Clinic, LLC

Clinic/Center · Atlanta, GA

NPI number1366711202
StatusActive
Last updated in NPPESDec 21, 2011

Details

NPI
1366711202
Entity type
Organization (NPI-2)
Legal business name
Aaa Waterford Medical Clinic, LLC
Organization subpart
No
Enumeration date
Dec 21, 2011
Last updated
Dec 21, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center07035065GAYes

Practice location

3069 Amwiler Rd
Suite 2
Atlanta, GA 30360-2825

Phone 678-969-9920 · Fax 678-969-9919

Mailing address

3069 Amwiler Rd
Suite 2
Atlanta, GA 30360-2825

Phone 678-969-9920 · Fax 678-969-9919

Authorized official

John Salinas
President / Ceo
4049929130

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